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Effective Management of Multiple Non-carious Cervical Lesions with Gingival Recession and Dentin Hypersensitivity: Two Cases Report of Combined Restorative and Periodontal Approach

  • Hyunkyung Kim (Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital) ;
  • Sungtae Kim (Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital) ;
  • Young-Dan Cho (Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital)
  • Received : 2024.04.19
  • Accepted : 2024.06.07
  • Published : 2024.06.30

Abstract

Managing multiple non-carious cervical lesions (NCCLs) with gingival recession and dentin hypersensitivity can be challenging. Herein, we present two cases of successful treatment procedure for multiple NCCLs with gingival recession and dentin hypersensitivity using an envelope coronally advanced flap with CTG and composite resin restoration. Through the combined approach of restorative and periodontal procedure, both patients showed adequate extent of gingival coverage and esthetic outcome based on the Modified Root Coverage Esthetic Score (MRES) at 6 months postoperatively. Also, dentin hypersensitivity was reduced effectively during the follow up period. Although the pocket depth slightly increased in patient 1, possibly due to the amount of restoration located sub-gingivally, pocket depth remained within 3 mm. This suggest that re-establishing the clinical CEJ and performing partial restoration is advantageous for periodontal tissue and is expected to contribute to maintain gingival height in the long term. These case reports emphasize the efficacy of the combined approach for treating multiple NCCLs with gingival recession and dentin hypersensitivity, highlighting the importance of careful restoration planning for optimal clinical and aesthetic outcomes.

Keywords

References

  1. Hur B, Kim HC, Park JK, Versluis A. Characteristics of non-carious cervical lesions - an ex vivo study using micro computed tomography. J Oral Rehabil. 2011;38:469-74. https://doi.org/10.1111/j.1365-2842.2010.02172.x
  2. Teixeira DNR, Thomas RZ, Soares PV, Cune MS, Gresnigt MMM, Slot DE. Prevalence of noncarious cervical lesions among adults: A systematic review. J Dent. 2020;95:103285.
  3. Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Non-carious cervical lesions associated with gingival recessions: a decision-making process. J Periodontol. 2011;82:1713-24. https://doi.org/10.1902/jop.2011.110080
  4. Teixeira DNR, Zeola LF, Machado AC, Gomes RR, Souza PG, Mendes DC, Soares PV. Relationship between noncarious cervical lesions, cervical dentin hypersensitivity, gingival recession, and associated risk factors: A cross-sectional study. J Dent. 2018;76:93-7. https://doi.org/10.1016/j.jdent.2018.06.017
  5. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S204-13. https://doi.org/10.1002/JPER.16-0671
  6. Pini-Prato G, Franceschi D, Cairo F, Nieri M, Rotundo R. Classification of dental surface defects in areas of gingival recession. J Periodontol. 2010;81:885-90. https://doi.org/10.1902/jop.2010.090631
  7. Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol. 2014;41(Suppl 15):S44-62. https://doi.org/10.1111/jcpe.12182
  8. Prato GPP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L. Coronally advanced flap: The post-surgical position of the gingival margin is an important factor for achieving complete root coverage. J Periodontol. 2005;76:713-22. https://doi.org/10.1902/jop.2005.76.5.713
  9. Gennai S, Guiza ZB, Orsolini C, Gosset M. The influence of non-carious lesions in the surgical treatment of gingival recession: A systematic review & meta-analysis. J Dent. 2022;117:103922.
  10. Oliveira LML, Souza CA, Cunha S, Siqueira R, Vajgel BCF, Cimoes R. Treatment efficacy of gingival recession defects associated with non-carious cervical lesions: a systematic review. J Periodontal Implant Sci. 2022;52:91-115. https://doi.org/10.5051/jpis.2102580129
  11. Santos VR, Lucchesi JA, Cortelli SC, Amaral CM, Feres M, Duarte PM. Effects of glass ionomer and microfilled composite subgingival restorations on periodontal tissue and subgingival biofilm: a 6-month evaluation. J Periodontol. 2007;78:1522-8. https://doi.org/10.1902/jop.2007.070032
  12. Santamaria MP, Queiroz LA, Mathias IF, Neves FL, Silveira CA, Bresciani E, Jardini MAN, Sallum EA. Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial. J Clin Periodontol. 2016;43:461-8. https://doi.org/10.1111/jcpe.12524
  13. Santamaria MP, da Silva Feitosa D, Casati MZ, Nociti FH Jr, Sallum AW, Sallum EA. Randomized controlled clinical trial evaluating connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesion: 2-year follow-up. J Periodontol. 2013;84:e1-8. https://doi.org/10.1902/jop.2013.120447
  14. Martins TM, Bosco AF, Nobrega FJ, Nagata MJ, Garcia VG, Fucini SE. Periodontal tissue response to coverage of root cavities restored with resin materials: a histomorphometric study in dogs. J Periodontol. 2007;78:1075-82. https://doi.org/10.1902/jop.2007.060457
  15. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Mounssif I, Marzadori M, Montebugnoli L. Predetermination of root coverage. J Periodontol. 2010;81:1019-26. https://doi.org/10.1902/jop.2010.090701
  16. Santamaria MP, Silveira CA, Mathias IF, Neves FL, Dos Santos LM, Jardini MAN, Tatakis DN, Sallum EA, Bresciani E. Treatment of single maxillary gingival recession associated with non-carious cervical lesion: Randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration. J Clin Periodontol. 2018;45:968-76. https://doi.org/10.1111/jcpe.12907
  17. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000;71:1506-14. https://doi.org/10.1902/jop.2000.71.9.1506
  18. Carvalho PF, da Silva RC, Cury PR, Joly JC. Modified coronally advanced flap associated with a subepithelial connective tissue graft for the treatment of adjacent multiple gingival recessions. J Periodontol. 2006;77:1901-6. https://doi.org/10.1902/jop.2006.050450
  19. Santamaria MP, Mathias IF, Dias S, Jardini M, Junior MS, Sallum EA. Esthetic evaluation of different approaches to treat gingival recession associated with non-carious cervical lesion treatment: a 2-year follow-up. Am J Dent. 2014;27:220-4.
  20. Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol. 2009;80:705-10. https://doi.org/10.1902/jop.2009.080565
  21. Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5:8-13.
  22. Goodacre CJ, Eugene Roberts W, Munoz CA. Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration. J Prosthodont. 2023;32:e1-18. https://doi.org/10.1111/jopr.13585
  23. Zucchelli G, Testori T, De Sanctis M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage. J Periodontol. 2006;77:714-21. https://doi.org/10.1902/jop.2006.050038
  24. Basma HS, Saleh MHA, Abou-Arraj RV, Imbrogno M, Ravida A, Wang HL, Li P, Geurs N. Patient-reported outcomes of palatal donor site healing using four different wound dressing modalities following free epithelialized mucosal grafts: A four-arm randomized controlled clinical trial. J Periodontol. 2023;94:88-97. https://doi.org/10.1002/JPER.22-0172
  25. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol. 1997;24:808-13. https://doi.org/10.1111/j.1600-051X.1997.tb01194.x
  26. Chambrone L, Prato GPP. Clinical insights about the evolution of root coverage procedures: The flap, the graft, and the surgery. J Periodontol. 2019;90:9-15. https://doi.org/10.1002/JPER.18-0281
  27. Mclean TN, Smith BA, Morrison EC, Nasjleti CE, Caffesse RG. Vascular Changes Following Mucoperiosteal Flap Surgery: a Fluorescein Angiography Study in Dogs. J Periodontol. 1995;66:205-10. https://doi.org/10.1902/jop.1995.66.3.205